MEDICARE: DR. COLBY KIM GOMEZ DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1811	WY

General Provider Information

NPI Number	:	1598398935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLBY KIM GOMEZ DPT

Provider Business Mailing Address
First Line	:	170 YELLOW CREEK RD STE D
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5200
Country	:	US
Telephone Number	:	307-783-8068
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 YELLOW CREEK RD STE D
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5200
Country	:	US
Telephone Number	:	307-783-8068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	04/09/2026

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